title: Changing patterns in regionalization of perinatal care and the impact on neonatal mortality.
abstract: OBJECTIVE
  Our goal was to study changing patterns of low-birth-weight outcome over the past decade as deregionalized perinatal care has occurred.
  
  
  METHODS
  Live births and neonatal mortality for two 5-year periods (1982 to 1986 vs 1990 to 1994) were calculated by hospital of delivery in the state of Missouri. Self-designated level of perinatal care was contrasted with number of deliveries and nursery census to evaluate outcome. Regression models were constructed to compare outcome between levels of care.
  
  
  RESULTS
  There has been a significant shift of deliveries into self-designated level II and III perinatal centers. However, this is largely a result of redesignation of care rather than an actual increase in acuity or census. The relative risk of neonatal mortality for very-low-birth-weight infants is 2.28 in level II centers compared with level III centers, and is unchanged (2.57) from 10 years earlier. Nearly 14% of very-low-birth-weight deliveries still occur at non-level III centers.
  
  
  CONCLUSIONS
  Changing patterns of perinatal regionalization have not improved outcome for inborn infants < 1500 gm except in level III centers. Attempts should be made to deliver very-low-birth-weight infants in level III centers.
authors.affiliation: Perinatal Center, Saint Luke's Hospital of Kansas City, Kansas City, MO 64111, USA.
authors.forename: J D
authors.initials: JD
authors.lastname: Yeast
authors.forename: M
authors.initials: M
authors.lastname: Poskin
authors.forename: J W
authors.initials: JW
authors.lastname: Stockbauer
authors.forename: S
authors.initials: S
authors.lastname: Shaffer
mesh_terms: D001724:Birth Weight / Q000502:physiology; D005260:Female; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight / Q000502:physiology; D007363:Intensive Care Units, Neonatal / Q000592:standards; D016014:Linear Models; D008923:Missouri / Q000453:epidemiology; D018743:Perinatal Care / Q000592:standards*; D011247:Pregnancy; D011256:Pregnancy Outcome; D012041:Regional Medical Programs / Q000592:standards*